Minutes of the Health Commission Meeting
Tuesday, December 6, 2005
at 3:00 p.m.
101 GROVE STREET, ROOM 300
San Francisco, CA 94102
1) CALL TO ORDER
Commissioner Monfredini called the meeting to order at 3:15 p.m.
- Commissioner Lee Ann Monfredini, President – left at 5:30 p.m.
- Commissioner Roma P. Guy, M.S.W., Vice President
- Commissioner Edward A. Chow, M.D.
- Commissioner James M. Illig
- Commissioner Donald E. Tarver, II, M.D.
- Commissioner John I. Umekubo, M.D.
- Commissioner David J. Sanchez, Jr., Ph.D.
2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF NOVEMBER
Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Tarver,
Umekubo) approved the minutes of the November 15, 2005 Heath Commission
meeting, with two corrections. The first paragraph of page 13 was
changed to include all of the attendees from CPMC, and the Secretary’s
Note for Item 3.18 was changed to June 30, 2006.
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
Commissioner Illig chaired and Commissioner Chow attended the Budget
Committee meeting. Commissioner Sanchez was absent.
(3.1) PHP-Community Behavioral Health Services – Request for approval to
accept and expend funds from the SAGE Project, for evaluation of a
Center for a Substance Abuse Prevention project focusing on substance
abuse, HIV and Hepatitis prevention, in the amount of $205,000, for the
period of September 30, 2005 to September 29, 2010.
(3.2) PHP-Housing and Urban Health – Request for approval to accept and
expend a grant from the Department of Justice, in the amount of
$739,982, to expand the Direct Access to Housing program, for the period
of July 1, 2005 to June 30, 2006, and approval of a contract with the
Tenderloin AIDS Resource Center, in the amount of $505,308, for the same
(3.3) DPH-Central Administration – Request for approval of a contract
modification with P.B. Strategies, LLC, in the amount of $331,087, for a
new two-year total of $694,126, which includes a 12% contingency, to
provide strategic planning, project management and capital integration
services for the Department, for the period of July 1, 2005 through June
Secretary’s Note – the contract modification amount is $192,343, and the
two-year contract total is $731,841.
(3.4) AIDS Office-HIV Prevention – Request for approval of a retroactive
renewal contract with the Harm Reduction Coalition, in the amount of
$84,000, which includes a 12% contingency, to provide HIV Prevention
skills-building training services to HIV/AIDS service providers, for the
period of July 1, 2005 through June 30, 2006.
(3.5) AIDS Office-HIV Prevention – Request for approval of a retroactive
renewal contract with Better World Advertising, in the amount of
$175,840, which includes a 12% contingency, to provide the “HIV Stops
With Me” prevention education/social marketing campaign, for the period
October 1, 2005 through December 31, 2005.
(3.6) CBHS – Request for approval of a contract renewal with Sunny Hills
Children's Garden Family and Children's Services, in the amount of
$591,756, to provide mental health services for youth ages 12 through
18, for the period of July 1, 2005 through December 31, 2006.
- Commissioner Chow asked why the agency received a score of 2.5 in
Program Performance. Ms. Chan-Sew said that the agency inaccurately
calculated units of services, and the search for parental or kin
participation in family therapy has been challenging. Commissioner Chow
asked what will be done with Family Therapy Services. Barry Feinberg,
Sunny Hill chief operating officer, said they have put together
ambitious outreach and mechanisms to get families involved.
(3.7) CBHS – Request for approval of a retroactive contract renewal with
the Fred Finch Youth Center, in the amount of $315,257, to provide
therapeutic behavioral services and dual diagnosis mental health
services for adolescents, for the period of July 1, 2005 through
December 31, 2006.
Commissioner Chow clarified that the concerns about performance were
related to the residential program, and that this year we are not
contracting for these services. Ms. Chan-Sew said the residential
program would be closed because funding for Level 14 programs is
inadequate. Ms. Chan-Sew added that there is a high demand for Level 14.
DPH will have to refer to other places, some to Sunny Hill, some to
Seneca and elsewhere.
Commissioner Illig said that whenever an agency has a needs
improvement score, the contract summary needs to include an explanation.
(3.8) DPH-Office of Policy and Planning – Request for approval to
retroactively accept and expend a two-year contract from California
Managed Risk Medical Insurance Board, in the amount of $4,378,351, for
the Healthy Kids Project, for the period of July 1, 2005 through June
- Commissioner Illig asked if this revenue goes back into DPH. Mr. Soos
said he has been informed by the CFO that that the revenue would come
back to DPH and posted as excess revenue, and then be returned to the
(3.9) CHN-SFGH – Request for approval of two new retroactive contracts
with Crdentia Corporation and First Call Nursing Services, Inc., in the
amount of $2,700,000, to be shared with previously approved contractors:
Agostini Medical Staffing, Arcadia Health Services, Inc., HRN Services,
Inc., Medstaff, Inc., Nurse Providers, Inc. and United Nursing
International, to provide supplemental, temporary Per diem and Traveling
nursing personnel services for San Francisco General Hospital Medical
Center, for the period of November 15, 2005 through June 30, 2006.
- Commissioner Illig asked if the national firm complies with 12B.
Darius Zubrickas from Crdentia said yes. The benefits were already in
place for the San Francisco branch, but now the benefits extend to all
(3.10) AIDS Office-HIV Prevention – Request for approval of a
retroactive new contract with Tenderloin AIDS Resource Center, in the
amount of $135,165, including a 12% contingency, to provide Prevention
with Positives Program services in a clinical setting, for the period of
August 1, 2005 through June 30, 2006.
(3.11) AIDS Office-HIV Health Services – Request for approval of a
retroactive new contract with Patricia Sullivan Consulting, in the
amount of $149,744, which includes a 12% contingency, to provide
professional consultation services to support the Community of Color
Community-Based Organizations Capacity-Building Project, for the period
of August 1, 2005 through July 31, 2006.
Secretary’s Note – this contract was continued to the December 13, 2005
Health Commission meeting.
(3.12) AIDS Office-HIV Prevention – Request for approval of a
retroactive new contract with Patricia Sullivan Consulting, in the
amount of $75,661, which includes a 12% contingency, to provide
professional consultation services to support the Transgender Capacity
Building – In-Depth Needs Assessment and Clinical Best Practices
Development program, for the period of September 30, 2005 through
September 29, 2006.
Secretary’s Note – this contract was continued to the December 13, 2005
Health Commission meeting.
(3.13) CBHS – Request for approval of a retroactive contract renewal
with Westside Community Mental Health Center, Inc., in the amount of
$1,700,205 per year, for a total contract amount of $3,808,459, which
includes a 12% contingency, to provide a Single Point of Responsibility
program serving severely mentally ill adults, for the period of July 1,
2005 through June 30, 2007.
Secretary’s Note – Commissioner Tarver abstained from voting on this
- Commissioner Illig asked how the program would be evaluated. Mr.
Batonbacal, Director of CBHS Adult Services, said DPH commissioned a
five-year study to evaluate this program to look at whether the program
resulted in reduced costs to the system. In addition, CBHS has embarked
on a program review redesign process where they will take a better look
at outcomes and timely performance review reports. Commissioner Illig
asked why there is a cost differential between Westside & UCSF. Mr.
Batonbacal said the different is approximately $1,500 per patient.
Commissioner Illig said the Health Commission would be very interested
in the results of the five-year study, perhaps through a joint
- Commissioner Chow asked what Assertive Community Treatment is. Dr.
Boles, Westside Executive Director, said it is San Francisco’s attempt
to implement a national model to identify clients that are costly to the
system and develop an individualized, wrap around treatment plan to keep
individuals out of the hospital. This is a very intensive program. Dr.
Boles said they are working with DPH to revise outcome objectives to
reflect individual client improvements, rather than things such as
number of visits.
(3.14) CBHS – Request for approval of a retroactive contract renewal
with Regents of the University of California, on behalf of the UCSF
Clinical Practice Group, in the amount of $2,954,497 per year, for a
total contract amount of $6,618,073, which includes a 12% contingency,
to provide a Single Point of Responsibility program serving severely
mentally ill adults, for the period of July 1, 2005 through June 30,
(3.15) CBHS – Request for approval of a retroactive contract renewal
with Conard House, Inc., in the amount of $7,921,514, to provide
residential, outpatient, supportive housing and vocational training
mental health services, for the period of July 1, 2005 through December
- Commissioner Illig asked if there are plans to expand the board beyond
five members. Richard Heasley, Executive Director of Conard House, said
that board development has been an ongoing process, and they are always
recruiting new board members. They have had a lot of difficulty
exceeding five or six. Board members have to spend at least four hours a
month on board activities.
(3.16) CBHS – Request for approval of retroactive contract renewal with
the Edgewood Center for Children and Families, in the amount of
$6,157,478 per year, for a total contract value of $6,157,478, to
provide mental health services for the period of July 1, 2005 through
December 31, 2006.
Action Taken: The Health Commission (Chow, Guy, Illig, Monfredini,
Tarver, Umekubo) approved the Budget Committee Consent Calendar. Items
3.11 and 3.12 were continued to the December 13, 2005 Health Commission
meeting. Commissioner Tarver abstained from voting on Item 3.14.
4) DIRECTOR’S REPORT
Anne Kronenberg, Deputy Director of Health, presented the Director’s
AMA Hospital Recognition Program
Late last month, the American Medical Association recognized San
Francisco General Hospital Medical Center for developing exemplary
programs to improve communication between health care professionals and
patients. SFGHMC is one of eight hospitals nation-wide to receive the
honor, and was selected as part of the AMA Ethnical Force Program’s
Patient-Centered Communication Initiative. SFGHMC’s patient-centered
communication programs span a wide range of endeavors such as enhancing
chronic disease care, promoting shared decision-making and coping with
illness, developing efficient systems to improve medical interpretation,
targeting bi-lingual/bi-cultural concordance in mental health care, and
assisting immigrants and refugees in a healthy beginning.
The diversity of patients at SFGHMC is reflective of the diversity of
San Francisco and effective health care communication is critical to
ensure positive health care outcomes for SFGHMC’s patient population.
Language barriers, low health literacy levels and cultural difference
can all affect the quality of care that patients receive. This latest
recognition reflects the high quality standard of care that has become a
End of West Nile Virus Season
In the ironic realm of prevention as it relates to public health, you
know you’ve done a good job when nothing happens. Dr. Katz is therefore
pleased to report that West Nile Virus season has ended and San
Francisco had no reported cases of this infection in humans from a local
source. Three San Francisco residents became infected with the virus—two
contracted the disease from the Sacramento area and one from out of
State. Dr. Katz thanks Dr. Rajiv Bhatia and the great staff of the
Environmental Health Division as well as the other City departments that
worked to coordinate the West Nile Virus Prevention plan including the
Department of Public Works, the Recreation & Parks Department, the
Public Utilities Commission, the Department of the Environment and the
Fire Department. Of course it is possible to have a case post season and
of even greater concern is preventing human cases again next year.
Marc Trotz to Receive Francis J. Curry Award
Dr. Katz reported that Marc Trotz, Director of Housing and Urban Health
for DPH, has been named as a recipient of the 2006 Dr. Francis J. Curry
Award. Dr. Curry was a creative and innovative Director of Public Health
who championed low income, underserved populations in San Francisco. The
Curry Award is given each year to an individual or organization that
demonstrates Dr. Curry’s values in action. Previous winners have
included Rep. Nancy Pelosi, Senator Diane Feinstein and Supervisor Sue
Bierman. In naming Marc Trotz this year’s recipient, the Curry Senior
Center cited his “vision, approach and stewardship in developing
permanent supportive housing for homeless seniors…and his leadership in
implementing the Mayor’s Ten Year Plan, the outstanding work he has
championed in his role and his commitment to collaboration with
community groups, government entities, and service providers.” Marc will
receive the award in late March 2006. He shares the award with Dariush
Kayhan, Department of Human Services. Dr. Katz congratulated Marc for
this prestigious award.
US Trade Representative Advisory Committee
Mele Lau Smith of the Tobacco Free Project has been invited to be
nominated to serve on the advisory committee to the US Trade
Representative (USTR). The US is currently negotiating trade agreements
with significant implications for altering domestic U.S. laws and
policies, as well as those of our trading partners. Public health groups
have advocated that there be public health representatives represented
on the advisory committee to the USTR to ensure that public health
impacts are taken into account in developing U.S. trade policy. Dr. Katz
is confident that Ms. Smith will be a strong voice in representing
public health interests on this advisory committee.
- Commissioner Illig asked who gives the Francis Curry Award. Ms.
Kronenberg said the Curry Senior Center gives the award.
- Commissioner Monfredini asked what the census is at SFGH. Ms.
O’Connell said today’s census is 319. Ms. O’Connell acknowledged the
efforts of Liz Gray, DPH Director of Placement, for her work in getting
people out of SFGH and into community placements.
- Commissioner Illig asked if the private hospitals took any patients
from SFGH. Ms. O’Connell said that UC and CPMC were also full at the
same time as SFGH. St. Mary’s has willingly responded to SFGH’s
5) CONSIDERATION OF A RESOLUTION REGARDING ST. LUKE’S/CALIFORNIA PACIFIC
President Monfredini said this is the first time the Health Commission
is considering a resolution like the one being considered today, and
read the resolution.
- Commissioner Monfredini is pleased with the resolution and thanked
commissioners for their input.
- Commissioner Tarver said the resolution captures the essence of the
Health Commission’s discussion, and is an affirmation of the Health
Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Tarver,
Umekubo) amended the resolution to add “outpatient services” to the
fifth whereas clause.
Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Tarver,
Umekubo) approved Resolution #17-05, “Resolution Regarding the Merger of
California Pacific Medical Center and St. Luke’s Hospital,” as amended
6) CHARITY CARE REPORT FOR FISCAL YEAR 2004
Anne Kronenberg, Deputy Director of Health, Director, Office of Policy
and Planning and Alicia Neumann, Health Program Planner, presented the
FY 2004 Charity Care Report. This is the fourth Charity Care Report
Summary pursuant to the Charity Care Ordinance, and was prepared with
the participation of the Charity Care Project, which
represents the following charity care stakeholders in San Francisco:
California Pacific Medical Center, Consumers Union, Health Access, the
Hospital Council of Northern and Central California, Kaiser Permanente
Medical Center, Operation Access, Saint Francis Memorial Hospital, San
Francisco Community Clinic Consortium, the San Francisco Department of
Public Health, Service Employees’ International Union (SEIU) Local 250,
St. Luke’s Hospital, St. Mary’s Medical Center, and the University of
California, San Francisco Medical Center.
San Francisco’s Charity Care Ordinance focuses on one type of community
benefit, charity care, which is defined as the provision of health care
services without expectation of reimbursement to those who cannot afford
to pay. The Ordinance includes two requirements for nonprofit hospitals:
first, to notify patients of their charity care policies; and second, to
report to the Department of Public Health specific information about the
charity care that they provide.
Ms. Neumann presented the data from the 2004 Charity Care Report,
including information about applications/requests for charity care, the
number of unduplicated patients who receive charity care, the number and
type of services and the cost and expenditures. In general, Fiscal Year
2004 shows increased expenditures and decreased applications, patients
and services due to reported improvements in data collection. For Fiscal
Years 2001-2004, outpatient is increasing as a percentage of total
charity care, while emergency services are decreasing. Ms. Neumann noted
that SFGH’s reporting of charity care expenditures now includes the SF
Behavioral Health Center.
DPH analyzes hospital charity care by location, size and non-profit tax
benefits. In general, charity care shows a correlation with only patient
location, not hospital size or non-profit benefits. For Fiscal Years
2001-2004, tax benefits are increasing faster than charity care.
Findings and Recommendations:
- Hospitals should continue to pursue creative approaches to increase
outpatient charity care, especially for residents of Bayview/Hunters
Point, Potrero Hill, Tenderloin, Civic Center and Bernal Heights,
- The Department of Public Health and San Francisco’s hospitals should
promote the institutional reforms and community benefits reporting
recommended by the Public Health Institute in its demonstration project,
Advancing the State of the Art in Community Benefit.
- The Charity Care Project should continue to expand its
discussion to increase and improve the provision of charity care to
poor, uninsured and underinsured San Franciscans. There are four areas
they would like to focus on next year: coordination and consistency in
charity care services and reporting; expansion of services through
existing facilities and infrastructures; increased physician
participation in the provision of charity care; and coordination and
consistency in community benefits reporting.
Gene O’Connell, SFGH CEO and co-chair of the Hospital Council and Ron
Smith, Hospital Council Regional Vice President, gave an update on San
Francisco hospitals’ commitment to vulnerable San Franciscans. Every San
Francisco hospital has responded to the Health Commission’s
recommendation, in its December 7, 2004 resolution, that hospitals
increase the provision of outpatient charity care services in high-risk
neighborhoods. After that resolution was adopted, all 11 hospital CEOs
immediately met with SF Clinic Consortium and city clinic leaders and
established monthly meetings. Hospitals met with numerous community
groups such as St. Anthony’s Foundation and adult day care centers to
determine need. They reviewed current programs to improve and increase
funding and hospitals supported 110 programs in the targeted
neighborhoods. Mr. Smith updated the Commission on the African American
Health Disparity Project, including a $1 million allocation to treat
prostate cancer. Mr. Smith noted that every hospital is represented at
the Health Commission meeting. Mr. Smith gave examples of hospitals’
projects, including: $500,000 from UCSF for imaging services; $2.4
million from CPMC for specialty physician services for Clinic Consortium
clients; more than $2 million from St. Mary’s for clinic and hospital
services; more than $1 million from St. Francis for services to Glide
Clinic; $1.18 million from Kaiser Permanente in safety-net partnership
with Clinic Consortium and DPH to improve chronic care management; more
than 4,000 patient visits to St. Luke’s diabetes center; 12,000 services
provided by Chinese hospital through the Chinese Community Health
Resource center; and VA Medical Center is relocating and expanding its
service center for the homeless to a more convenient location on 3rd
San Francisco’s Charity Care Ordinance focuses on the specific type of
community benefit defined as charity care. Other activities that are
considered community benefits include such voluntary and involuntary
activities as health promotion and education; financial or in-kind
support of public health programs; medical education; research; and the
difference between cost and reimbursement for services provided to
beneficiaries of public insurance programs, such as Medi-Cal. However,
there is no standard definition of these activities, which precludes
consistent reporting of community benefit across hospitals. The report
includes a summary of hospitals’ community benefits activities, which
were presented by hospital representatives:
- Jeffrey Sterman, Pubic Affairs Director, Kaiser Hospital, introduced
Mike Alexander, Kaiser CEO. Mr. Sterman said Kaiser is now taking a look
to see what they could do to augment Kaiser’s decline in charity care,
which is partially due to ambulances not bringing indigent patients to
Kaiser. He distributed a copy of the 2005 community benefit plan (on
file in the Health Commission Office). Kaiser has a long-standing
partnership with community clinics, and is working with them on various
initiatives including chronic disease management. Kaiser is in
conversation with the Mayor’s Office, SF Health Plan and DPH to discuss
- Kieren Flaherty, Director of Local Governmental Relations, UCSF, said
that the Health Commission’s direction last year was very helpful in
allowing UCSF and other hospitals focus their scarce resources on areas
of greatest needs. UCSF is committed to the charity care process and is
looking at developing a traditional community benefits program that
mirrors what other hospitals do. Mr. Flaherty introduced Susan Moore
- Barry Lawlor, Director of Community Health, St. Mary’s Medical Center,
said different hospitals come with different specialties and abilities,
and St. Mary’s has been fortunate to have the Sister Mary Philipa
clinic. The zip code data has allowed St. Mary’s to identify patients
that could be served by Sister Mary Philipa but were instead going to
SFGH. He has worked closely with SFGH over the past year to address this
issue. He also discussed the St. Mary’s McAuley adolescent behavioral
unit, which is the only inpatient psychiatric program for youth in San
- Abby Yant, St. Francis Memorial Hospital, said a shared accomplishment
is the development of the DPH/CHW partnership. The LCR is now available
in St. Francis’s emergency room, which has been helpful to patients. St.
Francis has worked with DPH to provide other services; one on-going
discussion is psychiatric services. St. Francis awarded $100,000 to four
community clinics: Glide, St. Anthony’s, Curry Senior Center and South
of Market. This contribution was one part of a $500,000 donation from
St. Francis to the community. She emphasized the recommendation to work
with the Public Health Institute. This is a wonderful initiative.
- Terry Giovannini, Director of Community Health Programs at CPMC,
introduced Jim McCaughey, Vice President of Planning and Business
Development, and said that CPMC took the Health Commission’s
recommendation to heart last year to look at innovative ways to serve
outpatients in areas that have demonstrable need for care. It is CPMC’s
role as a non-profit institution to serve the community, and one way
they are doing so is through their charity care partnership fund. Many
services are offered that represent millions of dollars of efforts but
are not counted as charity care. CPMC is committed to increasing access.
- Jim Hickman, president of St. Luke’s Hospital Foundation, put a
personal face on charity care by describing the work of a respiratory
therapist at St. Luke’s. He also recognized Carla Rodriguez from St.
- Dick Hodgson, San Francisco Community Clinic Consortium, thanked Anne
Kronenberg for her leadership on the Charity Care Working Group, and for
recognizing the full range of community benefits. He also thanked the
Hospital Council for spearheading the meeting between hospital CEOs and
the Community Clinic Consortium. Together they can make a dent in the
problem of the growing uninsured population.
- Commissioner Monfredini thanked Ms. Kronenberg for her leadership. In
addition, she applauded the commitment of every single hospital to
participate in the monthly working group meetings.
- Commissioner Guy thanked the leadership around this issue, from DPH
and all the hospitals. This collaboration has been several years in the
making. It is really helpful that the hospitals focused on the clinical
aspects of their initiatives. This allows for an evaluation of impact
over time. She wants to acknowledge that, with the growing number of
people without health insurance, primary care and clinical care efforts
would not result in decreased emergency visits. This is a challenge, and
the report elucidates this.
- Commissioner Umekubo is gratified to see all the hospitals come
together. If we can identify common problems and pool resources, the
impact could be greater. Please keep the dialogue going.
- Commissioner Illig asked if patients must apply for charity care. Ms.
Neumann said that patients must apply. They can apply for charity care
after services have been provided. Commissioner Illig said it is
important to look at the issue of underinsured, as well as uninsured.
Because this demonstrates that hospitals are providing services that are
not fully reimbursed but do not meet the definition of charity care. He
is also glad to see the data on the direct grants provided by the
hospitals. He was surprised to see that St. Luke’s was able to give away
$3.5 million while at the same time losing $21 million. Mr. Hickman
replied that this was a one-time disbursement of endowment funds.
- Commissioner Chow is very pleased with the report. A year ago the
Public Health Institute convened the conference that the resolution
alludes to. This was a process that potentially allowed for a uniform
manner of recognizing community services that responded to uninsured and
underinsured. He attended that conference and believes that this could
be a framework that San Francisco hospitals use to report services. He
commends to the Commission that while they may not have process details,
pursuing this effort is worthwhile.
- Commissioner Tarver said that while the VA hospital is not required to
report charity care, have they been approached about voluntarily
participating. Ms. Kronenberg said they were invited to join the group,
but did not participate this past year. She will approach them again.
Commissioner Tarver said that medical groups are a key component of the
health care delivery system and it would be good if some of their data
could be captured. Commissioner Tarver asked how the Department, the
working group and the public track the impact that increased efforts
have on health outcomes, i.e. reduced rates of prostate cancer. Ms.
Kronenberg said the group would think about how to evaluate outcomes at
its upcoming meetings. Commissioner Tarver said this collaborative
effort has resulted in new services. He encouraged the group to look at
all of the monies that are available to geographic areas, including DPH
civil service programs, and all these efforts should be collaborative.
He also asked the group to consider how to expand notification to
patients that charity care is available. He said that CPMC has such a
large share of inpatient beds, has large charity care expenditures, but
the percentages, compared to licensed beds and tax benefit, is not as
large. He will be looking at how CPMC would be expanding that effort.
Jim McCaughey, CPMC, said CPMC recognizes that the number of beds does
not correlate to charity care because of barriers to accessing these
beds. They will be working on reducing these barriers throughout the
coming year. Commissioner Tarver noted that the ethnic breakdown of
CPMC’s charity care cases is not reflective on the community. This is
not surprising, but in the future he would like to see CPMC report on
how they reach other ethnicities, including African American and Latino
populations. Mr. McCaughey said they would be working on both the
application denials and ethnic breakdown.
- Commissioner Monfredini said that violence has increased over the past
years, and is clearly a public health issue. She asked the working group
to consider violence prevention, outreach, response and other
initiatives as an area to focus on. Mr. Smith said the Hospital Council
has discussed this at great length and would like to talk to the Health
Commission about this further.
Action Taken: The Commission approved Resolution #18-05, “Supporting
Recommendations Contained in the Fiscal Year 2004 Charity Care Report,”
7) ANNUAL ENVIRONMENTAL HEALTH REPORT ON REGULATORY ACTIVITIES
Rajiv Bhatia, M.D., Director, Environmental Health Section, presented
the annual update on EHS regulatory activities. Environmental Health is
responsible for environmental health broadly in San Francisco. They have
four major divisions: Environmental Health Regulatory Programs;
Children’s Environmental Health; Occupational Health; and the Program on
Health Equity and Sustainability. The focus of today’s presentation is
on regulatory programs. The programs constitute the largest share of
Environmental Health resources and staff, are a mandated county
responsibility, involve innovative practices and projects, and require
day to day collaboration among Environmental Health, DPH and sister
Dr. Bhatia said that 2005 was a challenging year because there was a
reduction in administration of staff at the same time that new programs
were added to environmental health. New programs: massage program;
retail tobacco program; weights and measures program; agriculture
programs; pesticide enforcement program; and Proposition 65 enforcement.
Dr. Bhatia introduced members of his staff, each of whom presented
regulatory program highlights.
Lisa O’Malley – Symbol of Excellence for Food Safety
Last Year, the Board of Supervisors established a Symbol of Excellence
Program to recognize high standards of food safety. Health Inspectors
calculate a score based on violations found through inspection. Food
establishments are required to post current inspection report on the
premises. Environmental Health will soon begin awarding a Symbol of
Excellence to establishments where three consecutive unscheduled
inspections result in scores greater than 90.
Environmental Health pilot tested a team approach to food safety
compliance education in Chinatown this year, which was very successful.
Environmental Health anticipates this program may become a model for a
citywide compliance education program.
Tom Rivard – Evaluating San Francisco’s Emergency Siren system
The City is required to have an emergency siren system. Background noise
affects effectiveness. Environmental Health is uniquely qualified to
evaluate these systems, and it enforces the City’s Noise Control
Ordinance through its Noise Program. The Noise Program supports OES and
DTIS in evaluating the acoustical coverage and design of the outdoor
emergency warning system.
Virginia St. Jean – Development of the Green Programs
One example of a Green Program is the work that was done around body
shops. Body shops regulated by DPH have great potential to reduce
toxics. Environmental Health developed best practice guidelines for the
industry. It did outreach and training to San Francisco-area businesses,
then gave Clean and Green Awards to compliant businesses. There will be
evaluation and broader use of guidelines in the region.
Helen Zverina – Success in Mosquito Control
Environmental Health coordinates and monitors the City’s preparation and
response to West Nile Virus. A network of local public agencies has
joined with DPH and community stakeholders to develop mosquito
prevention efforts. The State awarded Environmental Health with funding
for additional mosquito control technicians, equipment and supplies.
There were three West Nile cases in 2005. Next year, the Department will
be able to test dead birds in-house, thereby avoiding the usual 2-week
wait for results from the lab at UC Davis. DPH is developing structural
mosquito and rodent control via the Health Code.
Karen Cohn and Joe Walseth – Preventing Lead Poisoning through Candy.
Some candy products from Mexico contain lead, and results in potentially
significant exposure. EHS developed a community outreach strategy based
on local survey data to educate the community and generate interest in
the community for doing something about the problem. They notified
potential retailers about the potential hazards. At Environmental
Health’s request, the Board of Supervisors approved a resolution
encouraging swifter DPH and federal and state agency actions.
Dr. Bhatia – Improved Housing Conditions for Tenants of Residential
SRO health issues include crowding, insufficient bathrooms and kitchens,
repeated code violations, noise and tobacco smoke. Every year the
violations are corrected, and every year they occur. The voices have
been getting louder, and complaints more numerous. The Department has
been asked by the SRO Task Force to have a response. He presented the
spectrum of DPH’s response, which includes fines and penalties,
structural pest exclusion, property owner Health Code training, SRO
structural & operational changes, city vector control plan and tenant
education and communication.
Dr. Bhatia said that Environment Health activities enhance wellness, and
allow San Franciscans to have a higher quality of life. The Health
Commission could help in this effort by asking the question to other
entities in San Francisco: how are your efforts enhancing or detracting
from the health of San Franciscans? One potential is to hold joint
hearings with the Planning Commission and other commissions to talk
about issues that overlap both departments.
- Commissioner Guy reiterated that the focus of this report was on the
mandated, regulatory programs, which are not often highlighted and
recognized. These efforts contribute to our health and wellness.
- Commissioner Tarver appreciates the staff efforts across a broad swath
of responsibility. The food safety efforts are very concrete, as well as
the Clean and Green programs. He asked how these efforts are
communicated to the media in a positive way. Dr. Bhatia said there is a
green program website, a multiple-county listing of green businesses,
and periodic media references. Commissioner Tarver commended the SRO
efforts and asked if additional legislative, budget or other resources
are needed to make SROs safer and cleaner.
- Commissioner Umekubo asked how the issue of lead in Mexican candy was
initially identified. Dr. Bhatia said it is the FDA’s responsibility to
ensure that food that is imported is safe. They discovered through
testing approximately 10 years ago that Mexican candy is unsafe, and
then the State recognized this. But nothing was done except a letter of
warning to the industry. So local action was taken. Commissioner Umekubo
said there is a similar problem with mercury in fish—different State and
Federal standards, extensive lobbying, etc.
- Commissioner Illig asked if medical marijuana permitting is part of
Environmental Health’s responsibility. Dr. Bhatia said that DPH has 18
months to develop regulations, in concert with sister departments and
the industry. Then the regulations have to be published. They need to
hire a staff person. Once the regulations are approved, they will be
accepting applications. Commissioner Illig asked if this activity would
be sustained by fees. Dr. Bhatia said they’ve estimated a $3,000
application fee and an annual inspection fee to cover the full costs.
Commissioner Illig would like the Health Commission to consider joint
meetings with other commissions, such as the Planning Commission.
- Commissioner Chow supports the idea of joint meetings to discuss areas
of common interest. He is concerned but not surprised with the federal
government’s inattention to lead in candy. He is also concerned about
the conditions in SROs, particularly the cycle of recurring violations.
Perhaps DPH should investigate more frequently than once a year.
Commissioner Chow has been involved in rodent abatement effort in
District 3. This effort required community buy in. The SRO issue also
requires cooperative efforts, among different city agencies and the
community. He also wants to understand the new requirements around
tobacco enforcement, and do we know if the efforts actually result in
decreased smoking. Dr. Bhatia said that there is a behavioral survey of
youth smoking done nationally, and this provides periodic data. A new
element of the enforcement program is to revoke the permit for
establishments that are caught selling tobacco to minors. This effort
will also give data in the next few years.
8) PUBLIC COMMENT/OTHER BUSINESS
Michael Lipson spoke about lead paint in his apartment. He and his wife
became aware last March of a program through the Mayor’s Office of
Housing for a free lead paint inspection, which they participated in.
The inspection in June uncovered lead hazards in their flat. DPH issued
an abatement order, with a deadline of July 29th. It has been a
struggle, intensified by an uncooperative landlord, to get a safe living
environment, and DPH has not provided an adequate response. DPH punted
them to DBI, who referred them back to DPH. The lead remediation effort
has been inadequate. They brought in their own inspector. His wife and
baby have been unable to live in the apartment. His requests have been
ignored. He is looking for enforcement of the abatement order. Dr. Katz
said DPH has the most expertise around lead. The city’s system for
dealing with things like lead is bureaucratic and frustrating.
Commissioner Monfredini connected the family with Rajiv Bhatia, who will
follow up on the Lipson’s specific case.
The meeting was adjourned at 6:35 p.m.
Michele M. Seaton, Executive Secretary to the Health Commission
Health Commission meeting minutes are approved by the Commission at the
next regularly scheduled Health Commission meeting. Any changes or
corrections to these minutes will be reflected in the minutes of the
Any written summaries of 150 words or less that are provided by persons
who spoke at public comment are attached. The written summaries are
prepared by members of the public, the opinions and representations are
those of the author, and the City does not represent or warrant the
correctness of any factual representations and is not responsible for